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The International Writers Magazine: Care Issues

How to remain sane in a place of insanity.
• Rachel Green
Have you ever worked somewhere where everyone else around you is, in complete reality, totally nuts? You know the sort of place - where you look from person to person and genuinely don’t understand what is going on in their heads and coming out of their mouths. Where each day, your own mouth is agog going, “uh”?


This might be OK if you work in a crazy bar in New York or Rio and if by nuts, we mean jumping around downing shots, Coyote Ugly style.  Or, even, if you happen to be a mental health worker in a deprived area of a tough city, where you’re dealing with the fall out of drugs and alcohol abuse.

But, I’m talking about places in which children live and call their home. Perhaps I should qualify what I mean by nuts, which is actually a rather glib way to describe a very sad, very frightening truth.

In essence, I’m describing a care organisation which I’ve had the displeasure of getting to know in recent times. They have a glossy image of smiling faces and thriving lives, but underneath, there is a very disturbing reality.  I’m not talking about the types of abuse you sometimes hear about in these organisations, but it’s just as insidious – it’s to do with money.

In this organisation, employees and children’s health and safety is reduced to a minimum to cut costs and enable those at the top to carry on regardless, spouting their incredible facts and figures, trying to prove to all the important people that the right boxes are being ticked. It’s a place where the real needs of those who are really in need, are ignored and banished to a far corner of a boardroom, swept under the carpet in a litany of excuses about inadequate funding and resources.

In this care organisation, the people with the piggy bank will happily stamp all over the future happiness of the vulnerable people entrusted to them for the sake of money.
Well hang on a minute, what about the kids? 

Where is the promised intensive therapeutic intervention to help the chronic self-harmer for whom every waking thought is that he is better off dead?
Where is the daily psychotherapy to help the sixteen-year-old, trying to do life changing exams, for whom getting out of bed everyday is impossible due to severe depression?
Where are the sanctions for the fifteen-year-old who is climbing out of the window and into the cars of known sex offenders? Each one of these children is there because of severe abuse and neglect. Why are you abusing them again? 
Yes, yes. Money, money. Take a pay cut and sell your Audi then. Perhaps there is a lack of cash floating around in the worldwide pot, but you could make the figures work if you really wanted to, surely?
Am I just being naïve when I say that the children should be the priority?

So where does the blame lie?  Well, with those at the bottom of course, you say.
Those wretched people who work their bones off for pittance, only to be subjected to physical and verbal abuse daily, because you will not provide the guidance and resources to effectively manage challenging behaviour?
Those cretins, they bring the black eyes on themselves.

Instead of blaming the staff for their inadequacies, perhaps look at the organisation that you’re running. You have chronic levels of sickness and stress which flog the national average. You've more staff leaving than anyone cares to admit to. There are people who are actually afraid each and every day to go to work under you.

So, to answer my initial question. Could I remain sane? 
Well the answer is obviously no, because I am not there now. I got out, because I could.  

Left behind though, are many incredibly devoted, caring staff members who suffer on in unreasonable and potentially dangerous conditions, trying desperately (some more than others admittedly) to help these damaged and disturbed children. Many of them are unable to see a way out because of their own financial responsibilities and lack of other job prospects. These people are scared to stay, scared to go. What is most frightening of all is that these wonderful, selfless workers have one vital thing missing: the tools to do their job safely and effectively. 

By tools I mean imposed, meaningful systems of managing children’s behaviour. If you’re running a childcare organisation, surely you must understand even the most basics? Rewards and sanctions anyone? Choices and consequences? Empathy and love?

And how about making sure there are enough staff around to help when the fifteen-year-old boy with a history of serious violence has jumped on a female member of the team and is strangling her so hard she is about to pass out. Where were the staff? Oh yeah, off sick with stress.

The worrying thing is that these events occur so often that everyone is immune to them. Oh, yes, well actually you know, that’s nothing compared to what he did to so and so last week. Now, that was terrible. Why don’t you see that it’s your Duty of Care to provide adequate risk assessments and data to all staff working in close contact with the kids, to empower them with the knowledge they so desperately need to keep themselves and those in their care safe?

And so what about those left there who really cannot leave?
The dozens of children trapped by their own hellish life circumstances totally oblivious to the fact that their futures are being manipulated and permanently affected by bad management who lie and try to coerce their team workers to lie with them.  No, there hasn’t been a proper therapeutic care plan for the boy who was taken into care five years ago due to sexual abuse. And yes I will explain this to anyone who might happen to ask.

Do I have the answers?  No and yes. I know that these things sometimes do come down to money, but where else should the money go to, if not the distressed, damaged frightened children who have, through no fault of their own, found themselves in the care system? Isn’t it their money after all?  Don’t taxpayers pay happily for this sort of provision? Isn’t this what makes paying tax more palatable - the fact that there are people out there receiving it when it’s well and truly deserved?
What will it take for things to change?  A death I expect.  It’s as horrifically simple as that.

© Rachel Green June 2012

Readers Response from Douglas Engle June 23rd 2012

Hello Ms. Green,
I read your article, "How to Remain Sane in a Place of Insanity," on Hackwriters and I wanted to offer some feedback as a fellow care worker and social systems thinker.

To give you some background, I work in not-for-profit adult psychiatric rehabilitation, so I am at least familiar with direct care. I have never worked with youth. I began my work in a residential program where I routinely confronted bad policy and poor care decisions. Eventually I began cataloging these incidents, and brought them to my supervisor, and then her supervisor, and then eventually, rather than address my concerns, they offered me a transfer to a new site. Here, the conditions are better, but I have not stopped trying to improve my surroundings, even though we are regulated by the state, constrained by our budget, and forced into ridiculous contortions to help everyone but ourselves. It's the only thing I know to do.

I sympathize with your plight. A poorly run organization can be extremely demoralizing. I could tell by the tone of your article that you genuinely are at your wits end. I can only imagine this is because you do not see a choice to effect change in your circumstances. You wrote at length about the children not having the opportunities and the staff not having any options because the organization has all the power. You also wrote about the organization's concern only for money. It's an unfortunate reality that money is typically the driving force in any venture. Our organization has its own budget limitations that force us to approximate best practices. Thankfully my current boss acknowledges those limitations and works with us. Sometimes the ones in control are blind to everything that makes sense to us. As direct care staff and as individuals, we need to acknowledge that it's not everyone else's job to care about or even be aware of the things that mean the most to us. That's the definition of selfless work. We do it without recognition. It's also why we are trained in advocacy, because sometimes our clients need the recognition we can do without.

On the subject of recognition, I understand your concern for the children runs deep, but I fear your article tries to assert a moral argument to a purely economic question. People in general don't have to care about children, or the people who devote their lives to those children. People definitely don't owe us or our charges any money for our hardships; such is the nature of our private market economy. What this boils down to is, taxpayers don't pay happily for anything. The only reason adult rehab and youth development programs exist is to try to reduce the amount of dead weight the taxpayers already carry. If our programs did not reduce the overall financial burden levied on society by the populations we serve, there would be no point in paying us. Our services are cheaper than hospitals and jails. That's the rationale. Any positive moral side effects of this effort in loss mitigation are just that.

Therefore, we have to take control in our own right and do what is morally satisfying and correct to our conscience and damn the numbers. It's up to you to advocate for your clients, but be prepared for disappointment. If you get blocked by policy, there's always a way to change the policy, but it's going to take time. I know that the picture your article paints is a dreary one. A tremendous amount of proactive engagement is necessary to surmount those circumstances. You're going to be required to blind yourself to some of the realities you cannot change (like the audis, like the money, like the fact that the blame is always misplaced) and focus on what is within your ability to effect. If you can manage your expectations realistically, and continue to educate yourself about the nature of your health care system and its financial agenda, you will stay in control, and you will always have other options prepared. I do not seek to lay blame, but I am trying to heighten your sense of responsibility and your ability to handle it.

In this case, there were choices available to everyone you mentioned. Granted the consequences of those choices may not have been ideal, but there were alternatives. You got out of that organization. I'm sure others can, too. You could help them, if you choose to make that difference. Just think, where would that leave the organization without a staff? Detracting from a negative influence is one way of effecting positive change. Alternatively, you could have stayed, and it would have been frustrating- probably unsafe- but you could have looked to other programs and other professionals for guidance, and taken the lead developing new policies and putting them into effect in your own site. If the children are your main concern, you could have helped the children transfer to superior programs if you could not improve your own. Take the control away from the organization and do the work that you know is right. It all depends how much you care about your charges and believe in your own efficacy. I don't judge you for leaving, if that helps. I don't know enough about the specifics of your personal circumstance to properly assess your decision. Beyond that, I recognize that some choices incur too much personal cost, which is why we don't make them. The point is that you acknowledge that there were options and that you understand exactly why you made the one you did, and didn't make every other one.

One point I do take exception to is the end of your article as it descended into more of a rant. You said, perhaps hastily, it would take a death for things to change. If you've already acknowledged that someone is in danger of dying, (and now published it, even without specifics), and it happens, aren't you an accessory of sorts? Don't you have a duty to notify someone if there is apparent danger to or from a client? We do. It's one of the only times we can ever break client confidentiality privileges, so it's a big deal. You can tell by this point that I am not a typical moral crusader, but I do argue for congruency in thought and action. Given the sympathy in your writing, if you genuinely feel that someone is in immediate danger, it would seem congruent to me if you were taking some concrete measures to prevent harm, instead of writing ambiguously about it.

Lastly, I think your article is mis-titled and misses its aim. Resolving to wait by until someone you care deeply for dies is hardly a sane thing to do. You get sane by seeking therapy in any form, developing a plan, and changing behaviors that inhibit your growth. You take control and stop expecting everyone else to pick up the pieces of your puzzle. Writing a rant may be a good way to vent- and I appreciate that you've stepped forward to increase awareness of your concerns- but what you've published here is just that. Don't mis-title it as a self-helper. If you were prepared to leave the company, you would have been better off writing a detailed account of your experiences to a regulating agency and cc'ing your organization's executive officer. That said, I still feel your concerns are valid and more people need to be aware of your and similar predicaments. I also feel your case is illustrative of how difficult it is to be proactive in the face of immense forces. I think we could all use a little time to introspect, reevaluate the reality of our situation, define what we want, decide exactly what choices are available to us, at what costs, and resolve to employ ourselves exclusively to realize the visions we so desperately want to see. In the rehabilitation field, lives literally do depend on it, as you have made very clear.

Rachel, I hope you do find some sanity now that you're clear of this organization and that you continue striving to do the best for those you serve.
Douglas Engle, mental health advocate and case manager

How to get help for your kid before they go into care

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